Publications by authors named "Adriana Motta"

43 Publications

What's Eating You? Black Butterfly (Hylesia nigricans).

Cutis 2021 Feb;107(2):68-70

Dr. González is from the Dermatology Service, Kennedy Hospital, Bogotá, Colombia. Dr. Sandoval is from the Dermatology Program, El Bosque University, Bogotá. Drs. Motta and Rolón are from Simón Bolívar Hospital, Bogotá. Dr. Motta is from the Dermatology Service, and Dr. Rolón is from the Dermatopathology Service.

Lepidopterism refers to the adverse medical effects of contact with insects of the order Lepidoptera, which includes both moths and butterflies. These effects typically result from contact with an insect during the caterpillar (larval) stage. Lepidopterism involves multiple pathologic mechanisms, including direct toxicity of venom and mechanical irritant effects. Clinical patterns associated with contact with lepidoptera include localized stinging reactions, papular urticaria and dermatitis, urticarial wheals, and hemorrhagic diathesis. Accurate diagnosis of symptoms associated with contact with caterpillars, butterflies, or moths is nearly impossible without a reliable history of exposure, as the histology of exposure is nonspecific. Treatment is largely empiric and should be based on symptoms. We report a case of lepidopterism in a patient with acute cutaneous lesions following exposure to an adult-stage black butterfly (Hylesia nigricans).
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http://dx.doi.org/10.12788/cutis.0170DOI Listing
February 2021

Environmental Clonal Spread of Azole-Resistant with Erg11-Y132F Mutation Causing a Large Candidemia Outbreak in a Brazilian Cancer Referral Center.

J Fungi (Basel) 2021 Mar 30;7(4). Epub 2021 Mar 30.

Laboratory of Medical Mycology (LIM-53), Instituto de Medicina Tropical e Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-000, Brazil.

Clonal outbreaks due to azole-resistant (ARCP) isolates have been reported in numerous studies, but the environmental niche of such isolates has yet to be defined. Herein, we aimed to identify the environmental niche of ARCP isolates causing unremitting clonal outbreaks in an adult ICU from a Brazilian cancer referral center. sensu stricto isolates recovered from blood cultures, pericatheter skins, healthcare workers (HCW), and nosocomial surfaces were genotyped by multilocus microsatellite typing (MLMT). Antifungal susceptibility testing was performed by the EUCAST (European Committee for Antimicrobial Susceptibility Testing) broth microdilution reference method and was sequenced to determine the azole resistance mechanism. Approximately 68% of isolates were fluconazole-resistant (76/112), including pericatheter skins (3/3, 100%), blood cultures (63/70, 90%), nosocomial surfaces (6/11, 54.5%), and HCW's hands (4/28, 14.2%). MLMT revealed five clusters: the major cluster contained 88.2% of ARCP isolates (67/76) collected from blood (57/70), bed (2/2), pericatheter skin (2/3), from carts (3/7), and HCW's hands (3/27). ARCP isolates were associated with a higher 30 day crude mortality rate (63.8%) than non-ARCP ones (20%, = 0.008), and resisted two environmental decontamination attempts using quaternary ammonium. This study for the first time identified ARCP isolates harboring the Erg11-Y132F mutation from nosocomial surfaces and HCW's hands, which were genetically identical to ARCP blood isolates. Therefore, it is likely that persisting clonal outbreak due to ARCP isolates was fueled by environmental sources. The resistance of Y132F ARCP isolates to disinfectants, and their potential association with a high mortality rate, warrant vigilant source control using effective environmental decontamination.
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http://dx.doi.org/10.3390/jof7040259DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8066986PMC
March 2021

Chemoprophylaxis for babesiosis and anaplasmosis in cattle: case report.

Rev Bras Parasitol Vet 2020 27;29(4):e010520. Epub 2020 Nov 27.

Programa de Residência Profissional Integrada em Medicina Veterinária, Universidade de Passo Fundo - UPF, Passo Fundo, RS, Brasil.

Cattle tick fever (CTF) causes significant economic losses in the livestock sector. The pathogenic action of the hemoparasites is associated with anemia, weight loss, abortion and reduced productivity, which result with animal death. Programs to prevent CTF involve several procedures, including immunization, chemoprophylaxis and use of ectoparasiticides, together with the vector control in the environment. The objective of this study was to report an acute outbreak of CTF in a group of 157 Hereford cattle from a farm without presence of the vector, that were moved to a farm in the same state with a high tick infestation (Rhipicephalus microplus). On the day before the transportation, the animals received a chemoprophylaxis with imidocarb dipropionate (3 mg/kg, SC), which was repeated 21 days after the first application. After 42 days, some animals showed signs compatible with CTF, which was confirmed through clinical examination, necropsy, histopathological and hemoparasitological analyses. The morbidity rate was 37.6% and the mortality rate was 24.8%. Calves that were recently weaned were the group most affected with the tick fever, morbidity (100% and mortality (73%). Chemoprophylaxis in association with use of ectoparasiticides was not sufficient to control the outbreak of the disease.
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http://dx.doi.org/10.1590/S1984-29612020096DOI Listing
January 2021

The Dysfunctional Immune System in Common Variable Immunodeficiency Increases the Susceptibility to Gastric Cancer.

Cells 2020 06 19;9(6). Epub 2020 Jun 19.

Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisbon, Portugal.

Gastric carcinoma (GC) represents the most common cause of death in patients with common variable immunodeficiency (CVID). However, a limited number of cases have been characterised so far. In this study, we analysed the clinical features, bacterial/viral infections, detailed morphology and immune microenvironment of nine CVID patients with GC. The study of the immune microenvironment included automated digital counts of CD20+, CD4+, CD8+, FOXP3+, GATA3+ and CD138+ immune cells, as well as the evaluation of PD-L1 expression. Twenty-one GCs from non-CVID patients were used as a control group. GC in CVID patients was diagnosed mostly at early-stage ( = 6/9; 66.7%) and at younger age (median-age: 43y), when compared to non-CVID patients ( < 0.001). GC pathogenesis was closely related to infection ( = 8/9; 88.9%), but not to Epstein-Barr virus (0.0%) or cytomegalovirus infection (0.0%). Non-neoplastic mucosa (non-NM) in CVID-patients displayed prominent lymphocytic gastritis (100%) and a dysfunctional immune microenvironment, characterised by higher rates of CD4+/CD8+/Foxp3+/GATA3+/PD-L1+ immune cells and the expected paucity of CD20+ B-lymphocytes and CD138+ plasma cells, when compared to non-CVID patients ( < 0.05). Changes in the immune microenvironment between non-NM and GC were not equivalent in CVID and non-CVID patients, reflecting the relevance of immune dysfunction for gastric carcinogenesis and GC progression in the CVID population.
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http://dx.doi.org/10.3390/cells9061498DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7349552PMC
June 2020

First case report of nematode parasitic myelopathy in a wild feline in Brazil.

Rev Bras Parasitol Vet 2020 10;29(1):e014619. Epub 2020 Feb 10.

Laboratório de Patologia Animal, Programa de Pós-graduação em Bioexperimentação - PPGBIOEX, Faculdade de Agronomia e Medicina Veterinária - FAMV, Universidade de Passo Fundo - UPF, Passo Fundo, RS, Brasil.

Parasitic myelopathy caused by Gurltia paralysans in domestic cats is a disease commonly reported in several South American countries. The adult parasite is lodged in the meningeal veins and spinal cord, often causing clinical manifestations of vascular proliferation, thrombophlebitis, and medullary compression. Wild felines are believed to be the definitive hosts of this parasite. The infection occurs through the ingestion of paratenic hosts, but the life cycle of G. paralysans is not yet clearly understood. In this paper, we discuss a case of parasitic myelopathy in a margay (Leopardus wiedii) that died during post-surgical care. Necropsy revealed focal hemorrhages in the thoracolumbar spinal cord. A microscopic examination revealed adult nematodes and eggs inside the veins of subarachnoid space in spinal cord, suggesting G. paralysans infection. This is first description of parasitic myelopathy in a margay in Brazil.
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http://dx.doi.org/10.1590/S1984-29612019099DOI Listing
April 2020

Angiokeratomas, not everything is Fabry disease.

Int J Dermatol 2019 Jun 17;58(6):713-721. Epub 2019 Jan 17.

Dermatopathology Service, Simon Bolívar Hospital, Bogotá, Colombia.

Introduction: Angiokeratoma corporis diffusum are benign capillary malformations typically associated with Fabry disease and other lysosomal storage disorders. Only in a few cases they appear in healthy individuals.

Methods And Case: We carried out an exhaustive review of the literature on angiokeratomas and their main clinical, dermoscopy and histological features. Additionally, we reviewed the cases of healthy subjects illustrating the limitations of each case and comparing these results with our case.

Discussion: Angiokeratoma corporis diffusum is mostly related to Fabry disease and other lysosomal storage disorders. However, some cases may occur in apparently healthy individuals. Therefore, there is a increasing interest in its etiology, pathogenesis and clinical evaluation.

Conclusion: This is an academic-clinical review on angiokeratomas and their main implications in daily dermatological practice. Additionally, we report the first case in the literature of angiokeratoma corporis diffusum in a healthy patient with up-to-date laboratory methods currently available. The clinician should remember that not all angiokeratoma corporis diffusum occurs with lysosomal storage disorders.
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http://dx.doi.org/10.1111/ijd.14330DOI Listing
June 2019

Evaluation of Vitek MS for Differentiation of and Genotypes.

J Clin Microbiol 2019 01 2;57(1). Epub 2019 Jan 2.

Laboratorio de Micologia Médica (LIM 53), Instituto de Medicina Tropical, Universidade de São Paulo, São Paulo, Brazil

and are the main pathogenic species of invasive cryptococcosis among the species. Taxonomic studies have shown that these two taxa have different genotypes or molecular types with biological and ecoepidemiological peculiarities. Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) has been proposed as an alternative method for labor-intensive methods for and genotype differentiation. However, Vitek MS, one of the commercial MALDI-TOF MS instruments, has not been yet been evaluated for this purpose. Thus, we constructed an in-house database with reference strains belonging to the different (VNI, VNII, VNIII, and VNIV) and (VGI, VGII, VGIII, and VGIV) major molecular types by using the software Saramis Premium (bioMérieux, Marcy-l'Etoile, France). Then, this new database was evaluated for discrimination of the different genotypes. Our in-house database provided correct identification for all and genotypes; however, due to the intergenotypic mass spectral similarities, a careful postanalytic evaluation is necessary to provide correct genotype identification.
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http://dx.doi.org/10.1128/JCM.01282-18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6322467PMC
January 2019

Scabies herpeticum, an emerging clinical form of crusted scabies in AIDS patient: case report and literature review.

Int J Dermatol 2019 Oct 15;58(10):1205-1209. Epub 2018 Oct 15.

Medical Microbiology and Mycology Laboratory, El Bosque University, Bogota, Cundinamarca, Colombia.

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http://dx.doi.org/10.1111/ijd.14256DOI Listing
October 2019

Drug reaction with eosinophilia and systemic symptoms (DRESS) and multiple organ dysfunction syndrome (MODS): one more reason for a new effective treatment against leishmaniasis.

Int J Dermatol 2018 Nov 29;57(11):1304-1313. Epub 2018 Aug 29.

Advanced Training in Medicine & Postgraduate Medical Residency, University Hospital of the Samaritan ESE, Bogotá, Colombia.

Introduction: Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe drug-induced reaction associated with eosinophilia and systemic manifestations. Anticonvulsants, sulfonamides, and antivirals are the most related and described drugs in DRESS syndrome.

Methods And Case: We present a case of severe multiple organ dysfunction syndrome (MODS) with the risk of death associated with DRESS syndrome due to antileishmanial pentavalent antimonial drug and its simultaneous toxicity. Consequently, a comprehensive review of the main clinical problems and comparative discussion of both clinical conditions was made.

Discussion: The overlap of DRESS syndrome and antileishmanial pentavalent antimonial drug toxicity can be life-threatening. Both conditions represent a true clinical, diagnostic, and therapeutic challenge. We exposed specific clinical and laboratory results with rare occurrence.

Conclusion: Any physician and dermatologists should keep in mind the broad spectrum of clinical manifestations and laboratory findings associated with the use of pentavalent antimonial drugs. The clinical suspicion, an early diagnosis, and aggressive treatment are essential to prevent complications and death.
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http://dx.doi.org/10.1111/ijd.14126DOI Listing
November 2018

Lomentospora prolificans fungemia in hematopoietic stem cell transplant patients: First report in South America and literature review.

Transpl Infect Dis 2018 Aug 9;20(4):e12908. Epub 2018 May 9.

Central Laboratory Division-LIM03, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.

Lomentospora prolificans is a filamentous fungus and an emerging pathogen in immunocompromised patients. It is encountered most commonly in Australia, Spain, and USA. We described the first case of Lomentospora prolificans fungemia in South America. The patient was a hematopoietic stem cell transplantation (HSCT) recipient who developed the infection 37 days after stem cells infusion. In addition, we performed a literature review of invasive lomentosporiosis in HSCT patients.
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http://dx.doi.org/10.1111/tid.12908DOI Listing
August 2018

Candida blankii: an emergent opportunistic yeast with reduced susceptibility to antifungals.

Emerg Microbes Infect 2018 03 7;7(1):24. Epub 2018 Mar 7.

Laboratory of Medical Mycology - LIM-53, Hospital das Clínicas FMUSP and Instituto de Medicina Tropical de São Paulo, Universidade de São Paulo, São Paulo, 05403-000, Brazil.

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http://dx.doi.org/10.1038/s41426-017-0015-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5841406PMC
March 2018

Development of a membrane of poly (L-co-D,L lactic acid-co-trimethylene carbonate) with aloe vera: An alternative biomaterial designed to improve skin healing.

J Biomater Appl 2017 09 14;32(3):311-320. Epub 2017 Jul 14.

1 Faculdade de Ciencias Medicas e da Saude, Pontificia Universidade Catolica de Sao Paulo, São Paulo, Brazil.

The search for new therapies and drugs that act as topical agents to relieve pain and control the infectious processes in burns always attracted interest in clinical trials. As an alternative to synthetic drugs, the use of natural extracts is useful in the development of new strategies and formulations for improving the life quality. The aim of this study was to develop a wound dressing using Poly(L-co-D,L lactic acid-co-TMC) (PLDLA-co-TMC) containing aloe vera (AV). This natural plant extract is known for its modulatory effects under healing process. The membrane of PLDLA-co-TMC+aloe vera was prepared at different concentrations of AV (5, 10, 15 and 50%). The FTIR showed no change in the PLDLA-co-TMC spectrum after AV addition, while the swelling test showed changes only in PLDLA-co-TMC+AV at 50%. The wettability measurements showed decrease in the contact angle in all samples after the AV addition in the polymer, while the AV release test showed that PLDLA-co-TMC+50%AV sample has higher AV release rate than the sample with other AV concentrations. The SEM analysis showed that AV was homogeneously distributed at 5% only. Tensile tests demonstrated an increase in the Young's modulus and a reduction in the elongation till rupture of the PLDLA-co-TMC after the addition of AV. Biocompatibility in vitro evaluation with fibroblast cells seeded in the membranes of PLDLA-co-TMC+AV showed that the cells were able to adhere, proliferate and maintain mitochondrial activity in all AV concentrations tested. Due to the known skin medicinal properties attributed to AV and the results here obtained, we suggest that after in vivo trials, the PLDLA-co-TMC+AV should be a promising biomaterial for application as a device for skin curative and healing agent.
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http://dx.doi.org/10.1177/0885328217719854DOI Listing
September 2017

Epidemiology of rosacea in Colombia.

Int J Dermatol 2017 May 27;56(5):510-513. Epub 2017 Feb 27.

Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia.

Background: Prevalence of rosacea has been estimated around the world in the range of 0-22%. In Colombia, the prevalence of rosacea remains unknown. The aim of this study was to determine the prevalence of rosacea and the frequencies of its subtypes in Colombia.

Methods: This cross-sectional, multicenter study was conducted in six outpatient dermatology clinics across Colombia. A total of 33 dermatologists conducted a comprehensive medical history and physical examination for all rosacea patients seen at their offices over the course of 2 months. All patients who accepted to participate were encouraged to answer a survey about the history of their illness.

Results: Of 10,204 outpatients evaluated for rosacea between July and August 2014, 291 rosacea patients were included in this study. The prevalence of rosacea subtypes in this cohort was: 45.3% erythematotelangiectatic (ETR) (n = 132), 48.7% papulopustular (PPR) (n = 142), 4.8% phymatous (n = 14), and 1% ocular (n = 3).

Conclusions: Overall, the prevalence in Colombia was 2.85%. Our data represent an important first step to understanding the current state of rosacea in Colombia. The prevalence of rosacea in Colombia is the highest in Latin America among a few reports published, which might be explained by geographic features. However, contrary to our expectations, the prevalence is lower than that in some European countries. We postulate that this finding may be due to methodological differences.
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http://dx.doi.org/10.1111/ijd.13491DOI Listing
May 2017

Tumors on periorbital, axilla, and groin areas.

Int J Dermatol 2017 Feb 22;56(2):141-144. Epub 2016 Sep 22.

Radiology Service, Colombian National Cancer Institute, Bogotá, Colombia.

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http://dx.doi.org/10.1111/ijd.13414DOI Listing
February 2017

Identification of Candida haemulonii Complex Species: Use of ClinProTools(TM) to Overcome Limitations of the Bruker Biotyper(TM), VITEK MS(TM) IVD, and VITEK MS(TM) RUO Databases.

Front Microbiol 2016 16;7:940. Epub 2016 Jun 16.

Central Laboratory Division - LIM-03, Hospital das Clínicas da Faculdade de Medicina, Universidade de São PauloSão Paulo, Brazil; Laboratory of Medical Mycology - LIM-53, Hospital das Clínicas FMUSP and Instituto de Medicina Tropical de São Paulo, Universidade de São PauloSão Paulo, Brazil.

Candida haemulonii is now considered a complex of two species and one variety: C. haemulonii sensu stricto, Candida duobushaemulonii and the variety C. haemulonii var. vulnera. Identification (ID) of these species is relevant for epidemiological purposes and for therapeutic management, but the different phenotypic commercial systems are unable to provide correct species ID for these emergent pathogens. Hence, we evaluated the MALDI-TOF MS performance for the ID of C. haemulonii species, analyzing isolates/strains of C. haemulonii complex species, Candida pseudohaemulonii and Candida auris by two commercial platforms, their databases and softwares. To differentiate C. haemulonii sensu sctricto from the variety vulnera, we used the ClinProTools(TM) models and a single-peak analysis with the software FlexAnalysis(TM). The Biotyper(TM) database gave 100% correct species ID for C. haemulonii sensu stricto, C. pseudohaemulonii and C. auris, with 69% of correct species ID for C. duobushaemulonii. Vitek MS(TM) IVD database gave 100% correct species ID for C. haemulonii sensu stricto, misidentifying all C. duobushaemulonii and C. pseudohaemulonii as C. haemulonii, being unable to identify C. auris. The Vitek MS(TM) RUO database needed to be upgraded with in-house SuperSpectra to discriminate C. haemulonii sensu stricto, C. duobushaemulonii, C. pseudohaemulonii, and C. auris strains/isolates. The generic algorithm model from ClinProTools(TM) software showed recognition capability of 100% and cross validation of 98.02% for the discrimination of C. haemulonii sensu stricto from the variety vulnera. Single-peak analysis showed that the peaks 5670, 6878, or 13750 m/z can distinguish C. haemulonii sensu stricto from the variety vulnera.
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http://dx.doi.org/10.3389/fmicb.2016.00940DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4909767PMC
July 2016

Rapid identification of moulds and arthroconidial yeasts from positive blood cultures by MALDI-TOF mass spectrometry.

Med Mycol 2016 Nov 17;54(8):885-9. Epub 2016 Jun 17.

Laboratory of Medical Mycology - LIM-53, Hospital das Clínicas da FMUSP and Instituto de Medicina Tropical, Universidade de São Paulo, Brazil.

Moulds and arthroconidial yeasts are potential life-threatening agents of fungemia in immunocompromised patients. Fast and accurate identification (ID) of these pathogens hastens initiation of targeted antifungal therapy, thereby improving the patients' prognosis. We describe a new strategy that enabled the identification of moulds and arthroconidial yeasts directly from positive blood cultures by MALDI-TOF mass spectrometry (MS). Positive blood cultures (BCs) with Gram staining showing hyphae and/or arthroconidia were prospectively selected and submitted to an in-house protein extraction protocol. Mass spectra were obtained by Vitek MS™ system, and identifications were carried out with in the research use only (RUO) mode with an extended database (SARAMIS™ [v.4.12] plus in-house database). Fusarium solani, Fusarium verticillioides, Exophiala dermatitidis, Saprochaete clavata, and Trichosporon asahii had correct species ID by MALDI-TOF MS analysis of positive BCs. All cases were related to critically ill patients with high mortality fungemia and direct ID from positive BCs was helpful for rapid administration of targeted antifungal therapy.
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http://dx.doi.org/10.1093/mmy/myw044DOI Listing
November 2016

Genotyping of Fusarium Isolates from Onychomycoses in Colombia: Detection of Two New Species Within the Fusarium solani Species Complex and In Vitro Antifungal Susceptibility Testing.

Mycopathologia 2016 Apr 4;181(3-4):165-74. Epub 2016 Mar 4.

Laboratorio de Micología y Fitopatología, Departamento de Ciencias Biológicas, Universidad de Los Andes, Carrera 1 No 18A-10, Bogotá, Colombia.

Fusariosis have been increasing in Colombia in recent years, but its epidemiology is poorly known. We have morphologically and molecularly characterized 89 isolates of Fusarium obtained between 2010 and 2012 in the cities of Bogotá and Medellín. Using a multi-locus sequence analysis of rDNA internal transcribed spacer, a fragment of the translation elongation factor 1-alpha (Tef-1α) and of the RNA-dependent polymerase subunit II (Rpb2) genes, we identified the phylogenetic species and circulating haplotypes. Since most of the isolates studied were from onychomycoses (nearly 90 %), we carried out an epidemiological study to determine the risk factors associated with such infections. Five phylogenetic species of the Fusarium solani species complex (FSSC), i.e., F. falciforme, F. keratoplasticum, F. lichenicola, F. petroliphilum, and FSSC 6 as well as two of the Fusarium oxysporum species complex (FOSC), i.e., FOSC 3 and FOSC 4, were identified. The most prevalent species were FOSC 3 (38.2%) followed by F. keratoplasticum (33.7%). In addition, our isolates were distributed into 23 haplotypes (14 into FOSC and nine into FSSC). Two of the FSSC phylogenetic species and two haplotypes of FSSC were not described before. Our results demonstrate that recipients of pedicure treatments have a lower probability of acquiring onychomycosis than those not receiving such treatments. The antifungal susceptibility of all the isolates to five clinically available agents showed that amphotericin B was the most active drug, while the azoles exhibited lower in vitro activity.
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http://dx.doi.org/10.1007/s11046-016-9983-9DOI Listing
April 2016

Bilaminar Device of Poly(Lactic-co-Glycolic Acid)/Collagen Cultured With Adipose-Derived Stem Cells for Dermal Regeneration.

Artif Organs 2016 Oct 11;40(10):938-949. Epub 2016 Jan 11.

Department of Materials Engineering, Faculty of Mechanical Engineering, UNICAMP, Campinas, Brazil.

Several materials are commercially available as substitutes for skin. However, new strategies are needed to improve the treatment of skin wounds. In this study, we developed and characterized a new device consisting of poly(lactic-co-glycolic acid) (PLGA) and collagen associated with mesenchymal stem cells derived from human adipose tissue. To develop the bilaminar device, we initially obtained a membrane of PLGA by dissolving the copolymer in chloroform and then produced a collagen type I scaffold by freeze-drying. The materials were characterized physically by gel permeation chromatography, scanning electron microscopy, and mass loss. Biological activity was assessed by cell proliferation assay. A preliminary study in vivo was performed with a pig model in which tissue regeneration was assessed macroscopically and histologically, the commercial device Integra being used as a control. The PLGA/collagen bilaminar material was porous, hydrolytically degradable, and compatible with skin growth. The polymer complex allowed cell adhesion and proliferation, making it a potentially useful cell carrier. In addition, the transparency of the material allowed monitoring of the lesion when the dressings were changed. Xenogeneic mesenchymal cells cultured on the device (PLGA/collagen/ASC) showed a reduced granulomatous reaction to bovine collagen, down-regulation of α-SMA, enhancement in the number of neoformed blood vessels, and collagen organization as compared with normal skin; the device was superior to other materials tested (PLGA/collagen and Integra) in its ability to stimulate the formation of new cutaneous tissue.
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http://dx.doi.org/10.1111/aor.12671DOI Listing
October 2016

Rhizopus arrhizus and Fusarium solani Concomitant Infection in an Immunocompromised Host.

Mycopathologia 2016 Feb 7;181(1-2):125-9. Epub 2015 Sep 7.

Laboratory of Medical Mycology (LIM-53), Division of Dermatology Clinic, Hospital das Clínicas da FMUSP and Instituto de Medicina Tropical de São Paulo, Universidade de São Paulo, São Paulo, Brazil.

Neutropenic patients are at risk of the development of hyalohyphomycosis and mucormycosis. Correct identification is essential for the initiation of the specific treatment, but concomitant mold infections are rarely reported. We report one unprecedented case of concomitant mucormycosis and fusariosis in a neutropenic patient with acute myeloid leukemia. The patient developed rhino-orbital infection by Rhizopus arrhizus and disseminated infection by Fusarium solani. The first culture from a sinus biopsy grew Rhizopus, which was consistent with the histopathology report of mucormycosis. A second sinus biopsy collected later during the patient's clinical deterioration was reported as hyalohyphomycosis, and the culture yielded F. solani. Due to the discordant reports, the second biopsy was reviewed and two hyphae types suggestive of both hyalohyphomycetes and mucormycetes were found. The dual mold infection was confirmed by PCR assays from paraffinized tissue sections. Increased awareness of the existence of dual mold infections in at-risk patients is necessary. PCR methods in tissue sections may increase the diagnosis of dual mold infections. In case of sequential biopsies showing discrepant results, mixed infections have to be suspected.
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http://dx.doi.org/10.1007/s11046-015-9936-8DOI Listing
February 2016

Unusual Dermatological Manifestations of Gout: Review of Literature and a Case Report.

Plast Reconstr Surg Glob Open 2015 Jul 10;3(7):e445. Epub 2015 Aug 10.

Plastic and Reconstructive Surgery Department, Hospital Simón Bolivar, Bogota, Colombia; The Plastic and Reconstructive Surgery Department, Fundación Santa Fé de Bogotá, Bogota, Colombia; Plastic and Reconstructive Surgery Department, Hospital de la Policia, Bogota, Colombia; Hospital Simón Bolivar, Bogota, Colombia.

Background: Gouty panniculitis is a rare clinical manifestation of gout, characterized by deposits of monosodium urate crystals in the hypodermis. Our aim was to describe atypical and rare clinical presentations of gouty tophi.

Methods: We searched relevant English and Spanish literature of unusual gout manifestations using the following keywords: giant, gout, panniculitis, gouty panniculitis, gouty tophi, rare manifestations of gout, gouty, tophi, tophus, monosodium urate, uric acid, and unusual. Well-described case reports, case series, and review articles were evaluated and included in the literature review.

Results: International literature has reported fewer than 10 cases of gouty panniculitis worldwide. In this case report, the patient presents a rare manifestation of gouty panniculitis, with typical joint injuries, gouty tophi in both lower and upper extremities, chronic gouty tophi in the nose, for which only 3 cases have been reported in literature, and great hypertrophy of adipose tissue in the lower back.

Conclusions: Tophi can be found in atypical locations, which increase morbidities and deformities caused by the disease. We report an interesting case of gouty panniculitis associated with great hypertrophy of the adipose tissue, a rare manifestation of gout, and unusual locations of tophi. These clinical manifestations in our patient have not been recorded before, which leads us to think that we are in the presence of a new dermatological manifestation of gout.
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http://dx.doi.org/10.1097/GOX.0000000000000420DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4527619PMC
July 2015

Re-emergence of Chorioptes bovis (Acari: Psoroptidae) in cattle in the state of Rio Grande do Sul, Brazil.

Rev Bras Parasitol Vet 2014 Oct-Dec;23(4):530-3. Epub 2014 Dec 1.

Federal University of the Pampa - UNIPAMPA, Uruguaiana, RS, Brazil.

Here we describe an outbreak of chorioptic mange in cattle, 56 years after its first identification in Brazil. Between the months of June and July 2011, dermatitis characterized by alopecia and crusted and thickened skin at the insertion of the tail and in the ischiorectal fossa was recognized in 40 (35.7%) out of 112 Holstein cows on a farm in the northeastern mesoregion of the state of Rio Grande do Sul, Brazil. After diagnosing mange caused by Chorioptes bovis, the cows were weighed and treated with 0.5% ivermectin, as a pour-on single dose, and were separated into two groups: cows in early lactation and those in late lactation. The survival rate of C. bovis and the healing rate in the two groups of infested cows were monitored every seven days through skin scrapings. After 28 days of evaluation, the cure rate through treatment was greater among cows in early lactation (p <0.0001). The survival rate of C. bovis was higher in cows in late lactation.
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http://dx.doi.org/10.1590/S1984-29612014090DOI Listing
January 2017

Evaluation of the MALDI-TOF VITEK MS™ system for the identification of Candida parapsilosis, C. orthopsilosis and C. metapsilosis from bloodstream infections.

J Microbiol Methods 2014 Oct 26;105:105-8. Epub 2014 Jul 26.

Central Laboratory Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil.

Twenty-nine Candida parapsilosis, seventeen Candida orthopsilosis and two Candida metapsilosis bloodstream isolates were submitted for identification by VITEK-MS™ mass spectrometer. Four isolates, two C. orthopsilosis and two C. metapsilosis, were not identified. Inclusion of Superspectra of both species in this database is required to improve its discrimination power.
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http://dx.doi.org/10.1016/j.mimet.2014.07.018DOI Listing
October 2014

Synthesis, Characterization, and Osteoblastic Cell Culture of Poly(L-co-D,L-lactide-co-trimethylene carbonate) Scaffolds.

Int J Biomater 2014 25;2014:501789. Epub 2014 Jun 25.

Department of Materials Engineering, Faculty of Mechanical Engineering, State University of Campinas, Rua Mendeleyev 200, 13083-860 Campinas, SP, Brazil ; Laboratory of Biomaterials, Faculty of Medical Sciences and Health, Pontifical Catholic University of São Paulo, Rua Joubert Wey 290, 18030-070 Sorocaba, SP, Brazil ; Federal University of Sao Carlos, Rodovia João Leme dos Santos, Km 110, SP-264, Itinga, 18052-780 Sorocaba, SP, Brazil.

Lactide-based polymers have been widely investigated as materials for tissue engineering. However, characteristics such as low flexibility and elongation tend to limit particular applications, although these can be enhanced by adding plasticizers such as trimethylene carbonate (TMC) to the polymer chain of the copolymer poly(L-lactide-co-D,L-lactide) (PLDLA). The aim of this work was to synthesize and characterize a terpolymer of L-lactide, D,L-lactide, and TMC. The polymers were synthesized from 30% TMC by bulk polymerization and resulted in an average molar mass >10(5) g/mol. Thermal investigation of PLDLA-TMC showed a decrease in the glass transition and onset temperatures compared to PLDLA. PLDLA-TMC scaffolds stimulated the proliferation and normal phenotypic manifestations of cultured osteoblasts. These results show that it was possible to produce a terpolymer from L-lactide, D,L-lactide, and TMC. Scaffolds of this terpolymer had important characteristics that could be useful for applications in bone tissue engineering.
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http://dx.doi.org/10.1155/2014/501789DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4099256PMC
July 2014

Evaluation of VITEK 2 for discriminating Trichosporon species: misidentification of Trichosporon non-T. asahii.

Diagn Microbiol Infect Dis 2014 Sep 21;80(1):59-61. Epub 2014 May 21.

Laboratory of Medical Mycology (LIM-53) - Clinical Dermatology Division, Hospital das Clínicas da FMUSP and Instituto de Medicina Tropical de São Paulo, Universidade de São Paulo, Brazil. Electronic address:

The VITEK 2 system was evaluated for the identification of 74 Trichosporon invasive and non-invasive clinical isolates, comparing its results with the IGS1 sequencing. The system correctly identified Trichosporon asahii but not non-T. asahii isolates, which represented nearly 50% of the invasive infections in our nosocomial setting.
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http://dx.doi.org/10.1016/j.diagmicrobio.2014.05.017DOI Listing
September 2014

Death-associated odors induce stress in zebrafish.

Horm Behav 2014 Apr 5;65(4):340-4. Epub 2014 Mar 5.

Universidade de Passo Fundo (UPF), Curso de Medicina Veterinária, Campus I, Bairro São José, Caixa Postal 611, CEP 99001-970 Passo Fundo, RS, Brazil. Electronic address:

Living animals exploit information released from dead animals to conduct adaptive biological responses. For instance, a recently published study has shown that avoidance behavior is triggered by death-associated odors in zebrafish. Stress can clearly act as an adaptive response that allows an organism to deal with an imminent threat. However, it has not been demonstrated whether these chemical cues are stressful for fish. Here, we confirmed that dead zebrafish scents induce defensive behavior in live conspecifics. Additionally, we show for the first time in fish that these scents increase cortisol in conspecifics. To reach this conclusion, firstly, we exposed zebrafish to multi-sensorial cues (e.g., visual, tactile, chemical cues) from dead conspecifics that displayed defensive behaviors and increased cortisol. Also, when we limited zebrafish to chemical cues from dead conspecifics, similar responses arose. These responses coincide with the decaying destruction of epidermal cells, indicating that defensive and stress responses could take place as an effect of substances emanating from decaying flesh, as well as alarm substance released due to rupture of epidermal cells. Taken together, these results illustrate that living zebrafish utilize cues from dead conspecific to avoid or to cope with danger and ensure survival.
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http://dx.doi.org/10.1016/j.yhbeh.2014.02.009DOI Listing
April 2014

Seborrheic dermatitis: predisposing factors and ITS2 secondary structure for Malassezia phylogenic analysis.

Med Mycol 2013 Nov 15;51(8):868-75. Epub 2013 Aug 15.

* Laboratorio de Micología y Fitopatología, Departamento de Ciencias Biológicas Universidad de Los Andes , Bogotá

Seborrheic dermatitis (SD) is a chronic, widespread skin condition, which is considered a multifactorial disease influenced, in part, by Malassezia spp. opportunistic activities, as well as various endogenous and exogenous factors. Malassezia species are lipophilic, lipid-dependent yeasts that are members of the normal mycobiota of the human skin. Their isolation from SD lesions varies around the world and the study of the relationship among factors such as gender, age, immunosuppressive condition of the patient and SD development, can lead to a better understanding of this disease. To elucidate the association of age and gender with the development of SD and to precisely determine the Malassezia species involved in the disease, samples were obtained from 134 individuals, including individuals without lesions, human immunodeficiency virus positive patients, individuals with seborrheic dermatitis, and HIV patients with seborrheic dermatitis. Malassezia spp. were identified by phenotypic and genotypic methods and a phylogenetic analysis was performed using Bayesian inference. This study revealed that age and gender are not predisposing factors for SD development, and that the most frequent species of Malassezia related to SD development among the Colombian population is M. restricta. We also report the isolation of M. yamatoensis for the first time in Colombia, and propose an ITS2 secondary structure from Malassezia taxa that can be used for precise identification and to establish more robust phylogenetic relationships.
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http://dx.doi.org/10.3109/13693786.2013.820001DOI Listing
November 2013

Antimicrobial susceptibility of Propionibacterium acnes isolates from acne patients in Colombia.

Int J Dermatol 2013 Jun 3;52(6):688-92. Epub 2013 Mar 3.

Center for Clinical Studies, Houston, TX 77030, USA.

Background: The increasing prevalence of antimicrobial resistance in Propionibacterium acnes poses a significant challenge to successful treatment outcomes in acne patients. Although P. acnes resistance has been demonstrated throughout the world, no previous data regarding the antimicrobial susceptibility of P. acnes in Colombia are available.

Objectives: The aim of this study was to determine the antimicrobial susceptibility of P. acnes to common antibiotics used in the treatment of acne in a Colombian population.

Methods: Samples were collected from facial acne lesions of 100 dermatology patients. All samples were cultured in anaerobic conditions, and final identification of isolates was performed. Isolates of P. acnes were then subjected to antimicrobial susceptibility tests using erythromycin, clindamycin, tetracycline, doxycycline, and minocycline.

Results: Propionibacterium acnes isolates resistant to erythromycin (35%), clindamycin (15%), doxycycline (9%), tetracycline (8%), and minocycline (1%) were observed. Isolates with cross-resistance were also observed (to erythromycin and clindamycin [12%] and to doxycycline and tetracycline [6%]). Overall, 46% of isolates taken from patients with a history of antibiotic use demonstrated resistance, whereas 29% of isolates taken from patients who had never used antibiotics demonstrated resistance.

Conclusions: Antimicrobial resistance in P. acnes in this Colombian population has a lower prevalence than those reported in Europe and follows a similar pattern to findings elsewhere in Latin America. Resistance is demonstrated even in isolates from patients with no previous history of antibiotic use. Resistance to erythromycin is most commonly observed. Minocycline emerges as the most effective antibiotic.
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http://dx.doi.org/10.1111/j.1365-4632.2011.05403.xDOI Listing
June 2013

Multilocus sequence typing of Candida tropicalis shows the presence of different clonal clusters and fluconazole susceptibility profiles in sequential isolates from candidemia patients in Sao Paulo, Brazil.

J Clin Microbiol 2013 Jan 14;51(1):268-77. Epub 2012 Nov 14.

Medical Investigation Laboratory of Immunology, Clinics Hospital, Medical School, University of São Paulo (LIM-48), São Paulo, Brazil.

The profiles of 61 Candida tropicalis isolates from 43 patients (28 adults and 15 children) diagnosed with candidemia at two teaching hospitals in São Paulo, Brazil, were characterized by multilocus sequence typing (MLST). For the 14 patients who had bloodstream infections, 32 isolates were serially collected from their blood and/or catheters. Thirty-nine diploid sequence types (DSTs) were differentiated. According to the C. tropicalis MLST database (http://pubmlst.org/ctropicalis/), 36 DSTs and 23 genotypes identified from the 61 isolates had not previously been described. This report represents the first study to characterize sequential isolates of C. tropicalis from candidemia cases in South America. Microvariation in a single gene was found in the sequential isolates from 7 patients. The main polymorphisms occurred in the alleles of the XYR1 gene, specifically at nucleotide positions 215, 242, and 344. Macrovariation in six gene fragments was detected in the isolates from 3 patients. eBURST analysis added two new groups to this study (groups 6 and 18). Additionally, susceptibility tests indicate that 3 isolates were resistant to fluconazole. No correlation was found between the DSTs and susceptibility to fluconazole and/or selective antifungal pressure. Two patients were sequentially infected with resistant and susceptible strains. MLST is an important tool for studying the genetic diversity of multiple/sequential isolates of patients with candidemia, allowing the comparison of our data with those from other regions of the world, as well as allowing an analysis of the genetic relationship among several clones in sequential isolates from the same or different candidemia patient sites (blood or catheter).
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http://dx.doi.org/10.1128/JCM.02366-12DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3536249PMC
January 2013

First report of a clinical isolate of Candida haemulonii in Brazil.

Clinics (Sao Paulo) 2012 Oct;67(10):1229-31

Microbiology Section, Divisão de Laboratório Central, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo/SP, Brazil.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3460029PMC
http://dx.doi.org/10.6061/clinics/2012(10)18DOI Listing
October 2012
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